pancuronium and Hypertension

Topics: Adrenergic beta-Antagonists; Adult; Amphetamine-Related Disorders; Emergency Nursing; Emergency Treatment; Epilepsy, Tonic-Clonic; Fatal Outcome; Fever; Humans; Hypertension; Male; Medical Errors; Methamphetamine; Metoprolol; Neuromuscular Nondepolarizing Agents; Nurse's Role; Nursing Assessment; Pancuronium; Tachycardia

The effects of prophylactic infusion of 1 microgram X kg-1 X min-1 nitroglycerin (NTG) on the incidence of ischemia, hypertension, hypotension and perioperative myocardial infarction were studied in 81 patients during coronary artery bypass grafting (CABG). Forty-one patients (Group 1) received NTG and 40 patients (Group 2) received placebo. All patients received fentanyl for anesthesia and pancuronium. Mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), heart rate (HR), and cardiac output (CO) were measured before and after induction of anesthesia, after intubation, before and after chest incision, after sternotomy, after the pericardium was opened, and during normothermic cardiopulmonary bypass. Myocardial ischemia and infarction were diagnosed from the ECG, hypertension was defined as a 20% increase in MAP, and hypotension was defined as a 20% decrease in MAP compared with preinduction values. No significant differences between Groups 1 and 2 in HR, PCWP, or CO were seen. MAP was significantly lower in Group 1 than Group 2 (P less than 0.05) before chest incision, but increased to levels equal to Group 2 after sternotomy. Hypertension occurred in 32 Group 2 patients and 25 Group 1 patients (0.05 less than P less than 0.1). Group 1 patients had 0.95 +/- 0.14 episodes per patient of hypertension, while Group 2 patients had 2.10 +/- 0.31 episodes (P less than 0.05). Hypotension occurred in 20 Group 1 patients but only six Group 2 patients (P less than 0.05). There was no difference in the incidence of ischemia. In Group 1, nine patients (22%) had ECG changes of ischemia, while 12 patients in Group 2 (30%) had ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anesthesia; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Creatine Kinase; Electrocardiography; Fentanyl; Heart Rate; Humans; Hypertension; Hypotension; Nitroglycerin; Pancuronium; Pulmonary Wedge Pressure; Tachycardia

Topics: Adult; Aged; Anesthetics; Arrhythmias, Cardiac; Diazepam; Hemodynamics; Humans; Hypertension; Ketamine; Middle Aged; Morphine; Myocardial Revascularization; Nitrous Oxide; Pancuronium; Postoperative Complications

Topics: Analgesics; Anesthesia; Anesthetics, Inhalation; Anesthetics, Intravenous; Child, Preschool; Ductus Arteriosus, Patent; Fentanyl; Heart Septal Defects, Ventricular; Humans; Hypertension; Intubation, Intratracheal; Isoflurane; Ketamine; Male; Monitoring, Intraoperative; Neuromuscular Nondepolarizing Agents; Oxygen; Pancuronium; Pulmonary Artery; Radiography

We report two cases of patients who underwent simultaneous triple transplants (liver-pancreas-kidney) using organs taken from a single donor in each case. The anesthetic technique and perioperative treatment of each patient is described. The favorable evolution in both cases seems to indicate that although this type of transplant may be more complex, it is nevertheless a good therapeutic option for patients suffering terminal liver failure, kidney failure or diabetes type I.

Topics: Adult; Anesthesia, General; Cardiomyopathy, Hypertrophic; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Etomidate; Female; Fentanyl; Hemodynamics; Hepatitis C, Chronic; Humans; Hypertension; Intraoperative Care; Isoflurane; Kidney Transplantation; Lidocaine; Liver Cirrhosis; Liver Transplantation; Male; Midazolam; Middle Aged; Pancreas Transplantation; Pancuronium; Pleural Effusion; Postoperative Complications; Reoperation; Smoking; Succinylcholine

Abnormal hypertension sometimes occurs following intravenous administration (i.v.) of pancuronium in patients with brain injury. The present experiment was designed to determine whether brain injury contributes to the hypertensive response of i.v. pancuronium. Forty-six Wister strain rats were studied, of which 39 had induced brain injury at (a) upper pons (b) midbrain (c) thalamus region (excluding hypothalamus) and (d) cerebellum or a combination of these sites. The injury was made by single insertion of a 22 Gauge needle through the skull surface. The quantity of pancuronium solution administered i.v. in each case was 1.0 ml containing either 0.8 mg/kg or 8 mg/kg of pancuronium. Group A (n = 7) had no brain injury and the mean arterial pressure (MAP) did not change following i.v. administration of pancuronium. In Group B (n = 9) (a+b+c, 8.0 mg/kg) MAP rose from 90.9 +/- 15.4 to 102 +/- 22.0 mmHg and in Group C (n = 7) (a+b+c, 0.8 mg/kg) MAP rose from 148.4 +/- 13.3 to 160 +/- 14.4 mmHg. In Group D (n = 5) (b+c, 8.0 mg/kg) MAP remained unchanged. In Group E (n = 5) (a, 8.0 mg/kg) MAP rose from 130.3 +/- 18.7 to 146 +/- 27.6 mmHg and in Group F (n = 6) (a, 0.8 mg/kg) MAP rose from 129.7 +/- 15.6 to 135.8 +/- 13.8 mmHg. In Group G (n = 7) (d, 8.0 mg/kg) MAP remained unchanged. Since the MAP was elevated in only those groups that received injury in the upper pons, we concluded that injury in the upper pons can lead to hypertension following i.v. administration of pancuronium.

Topics: Animals; Blood Pressure; Brain Injuries; Dose-Response Relationship, Drug; Female; Hypertension; Injections, Intravenous; Male; Osmolar Concentration; Pancuronium; Rats; Rats, Wistar

Sequential radionuclide imaging and continuous recording of arterial and right heart pressures were carried out during anaesthesia with midazolam 0.2 mg kg-1, pancuronium 0.15 mg kg-1 and fentanyl 10 micrograms kg-1 in eight patients with normal cardiopulmonary status scheduled for craniotomy. The aim was to examine how a stress-free anaesthetic induction tailored to protect against the hypertension and tachycardia provoked by laryngoscopy and intubation influenced left-ventricular performance, left-ventricular loading conditions and plasma catecholamine concentrations. During the 20-min study period no significant changes were observed in heart rate, left-ventricular ejection fraction, ratio of peak systolic pressure to left-ventricular end-systolic volume, pulmonary capillary wedge pressure, left-ventricular end-systolic volume, cardiac output, dopamine and noradrenaline concentrations. Except for a minor increase in mean arterial pressure after laryngoscopy and intubation, mean arterial pressure decreased 24%, left-ventricular end-diastolic volume decreased 15%, and left-ventricular stroke volume decreased 21%. Central venous pressure increased by 75% but there was no parallel increase in pulmonary wedge pressure, which in turn did not reflect the alterations in ventricular end-diastolic volume. Plasma adrenaline concentrations decreased significantly (66%). The chosen induction regimen preserved global left-ventricular pump function during laryngoscopy and intubation without any activation of the sympathetic nervous system. Central venous and pulmonary wedge pressures were unreliable in the assessment of ventricular preload during induction of general anaesthesia.

Topics: Adult; Anesthesia, Intravenous; Blood Pressure; Cardiac Catheterization; Cardiac Volume; Epinephrine; Female; Fentanyl; Gated Blood-Pool Imaging; Heart Rate; Humans; Hypertension; Laryngoscopy; Male; Midazolam; Middle Aged; Monitoring, Physiologic; Pancuronium; Stroke Volume; Tachycardia; Vascular Resistance; Ventricular Function, Left

The hypothesis that adenosine mediates blood flow increments in contracting skeletal muscle was evaluated by intravital microscopy of the microcirculation in the tenuissimus muscle of anesthetized rabbits. Motor nerve stimulation elicited muscle contractions and frequency-dependent arteriolar dilatation, particularly in terminal arterioles. The pulse duration (0.05 ms) and voltage (1.5-5 V) precluded activation of vasoconstrictor fibers, as also indicated by the lack of effect of phentolamine on resting vascular tone and on the hyperemic response to nerve stimulation. The specific adenosine receptor antagonist, 1,3-dipropyl-8-p-sulfo-phenylxanthine (DPSPX; 10(-5) M), attenuated the hyperemic response to muscle contractions. The adenosine uptake inhibitor dipyridamole (10(-8)-10(-6) M) dose-dependently dilated microvessels, an effect prevented by DPSPX (10(-5) M). Moreover, dipyridamole (10(-7) M) augmented contraction-induced hyperemia. The enhancement by dipyridamole was reversed by DPSPX (10(-5) M). The effects of adenosine uptake inhibitor and antagonist were invariably more marked in terminal than in transverse arterioles, and also more pronounced at higher stimulation frequencies. Motor nerve stimulation failed to induce alterations in vascular diameters when the neuromuscular junction was blocked by pancuronium. Thus, our observations indicate that functional hyperemia after motor nerve-induced contractions of the skeletal muscle was of postjunctional origin. Apparently, activation of adenosine receptors was responsible for a part of the evoked vasodilation.

Topics: Adenosine; Administration, Topical; Animals; Arterioles; Dipyridamole; Dose-Response Relationship, Drug; Electric Stimulation; Hypertension; Injections, Intravenous; Male; Motor Neurons; Muscles; Pancuronium; Rabbits; Xanthines

Topics: Anesthesia, Inhalation; Child, Preschool; Halothane; Humans; Hypertension; Male; Moyamoya Disease; Nitrous Oxide; Pancuronium

Severe hypertension, tachycardia or ECG changes have been reported following i.v. administration of pancuronium to patients with pheochromocytoma or bronchial asthma. These cardiovascular changes were explained by an interaction between autonomic effects of pancuronium and elevated serum catecholamines or aminophylline. We noted similar cardiovascular changes associated with i.v. administration of pancuronium in two patients after successful cardiopulmonary resuscitation and in two with midbrain hemorrhage and epidural hematoma. In these patients, pancuronium produced no abnormal cardiovascular changes when given during elective surgery or before the occurrence of midbrain hemorrhage. Thus, ischemic brain damage may play a role in producing the severe cardiovascular changes associated with pancuronium.

Topics: Aged; Brain Injuries; Electrocardiography; Female; Humans; Hypertension; Male; Middle Aged; Pancuronium; Resuscitation; Tachycardia

Topics: Anesthesia, General; Drug Hypersensitivity; Humans; Hypertension; Male; Middle Aged; Pancuronium

Topics: Adolescent; Drug Resistance; Female; Humans; Hypertension; Pancuronium; Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Tachycardia

Topics: Adrenal Gland Neoplasms; Adult; Anesthesia; Humans; Hypertension; Jaw Fractures; Labetalol; Male; Pancuronium; Pheochromocytoma; Vecuronium Bromide

Topics: Adrenal Gland Neoplasms; Adult; Humans; Hypertension; Male; Neuromuscular Blocking Agents; Pancuronium; Pheochromocytoma; Tachycardia

Administration of tubocurarine, pancuronium, gallamine, or decamethonium into the cisterna magna of chloralosed dogs induced a rise in blood pressure. Clonidine (3 micrograms/kg) administered into the cisterna magna after tubocurarine, pancuronium, or gallamine significantly increased blood pressure; no significant change was found after decamethonium. The pressor response to clonidine after tubocurarine was antagonized by injection of the alpha 1-adrenoceptor-blocking agents AR-C 239 or prazosin into the cisterna magna at low doses prior to injection of clonidine. Yohimbine, a preferential alpha 2-adrenoceptor-blocking agent was ineffective. It is suggested that the pressor response to intracisternal clonidine after intracisternal tubocurarine is due to stimulation of alpha 1-adrenoceptor stimulation.

Topics: Adrenergic alpha-Antagonists; Animals; Blood Pressure; Cisterna Magna; Clonidine; Decamethonium Compounds; Dogs; Female; Gallamine Triethiodide; Hypertension; Male; Neuromuscular Nondepolarizing Agents; Pancuronium; Prazosin; Pressoreceptors; Receptors, Adrenergic, alpha; Stimulation, Chemical; Tubocurarine; Yohimbine

The hemodynamic effects of isoflurane and halothane when used to control intraoperative hypertension were evaluated in 20 patients undergoing coronary artery bypass grafting. The patients were anesthetized with flunitrazepam, fentanyl, pancuronium, and N2O-O2. Control measurements were made after skin incision. When mean arterial pressure increased to 110 mm Hg due to sternal spread or surgical manipulation of the aorta, isoflurane or halothane were used to return arterial pressure to control levels. Using a non-rebreathing system, inspired isoflurane concentrations of 1.5-2.0 vol% or halothane concentrations of 1.0-1.5 vol% were necessary. Measurements were repeated during the hypertensive episode and after treatment with isoflurane or halothane while surgical stimulation continued. Both inhalation anesthetics decreased arterial pressure to baseline values within 5-10 min. The lowering of arterial pressure with halothane was not accompanied by significant decreases in the elevated systemic vascular resistance and pulmonary capillary wedge pressure. Cardiac index and stroke volume index decreased markedly when halothane was used (18% and 25%, respectively). In contrast, isoflurane significantly decreased systemic vascular resistance (42%). This reduction of left ventricular afterload was associated with an increase in cardiac index (22%) and a decrease in left ventricular filling pressure. Heart rate did not change significantly. These findings indicate that isoflurane is superior to halothane for controlling intraoperative hypertension during coronary artery bypass surgery.

Topics: Adult; Anesthesia, General; Coronary Artery Bypass; Fentanyl; Flunitrazepam; Halothane; Hemodynamics; Humans; Hypertension; Intraoperative Complications; Isoflurane; Methyl Ethers; Middle Aged; Nitrous Oxide; Pancuronium

Topics: Adrenal Gland Neoplasms; Female; Humans; Hypertension; Middle Aged; Pancuronium; Pheochromocytoma

We have attempted to present a brief overview of current considerations in anesthesia for surgery of gastrointestinal disease as practiced at our institution. Many considerations remain unexplored owing to limitations of space. We have deliberately concentrated upon antecedent and concurrent therapy encountered in the treatment of the surgical patient. The potent drugs introduced in the past decade have produced infinite potential for drug interactions--some serious, some not so serious, and some which are desirable. We hope we have generated further reader interest in this mushrooming problem of modern medicine confronting the anesthesiologist and surgeon in the perioperative period.

Topics: Aged; Anesthetics; Drug Interactions; Enflurane; Female; Gastrointestinal Diseases; Halothane; Humans; Hypertension; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intussusception; Ketamine; Lung Diseases; Obesity; Pancuronium; Pregnancy; Pyloric Stenosis

Topics: Anesthesia, Inhalation; Animals; Blood Pressure; Blood-Brain Barrier; Carbon Dioxide; Cerebral Arteries; Evans Blue; Halothane; Hypertension; Nitrous Oxide; Norepinephrine; Pancuronium; Rabbits; Thiopental; Vasoconstriction; Vasodilation

Intravenous dose-response relationships were used to correlate neuromuscular paralysis with effects on autonomic mechanisms in anaesthetized cats. Whereas autonomic blockade with tubocurarine occurred at parasympathetic and sympathetic ganglia, neuromuscular paralysing doses of gallamine, alcuronium, pancuronium and fazadinium caused blockade at vagal postganglionic sites in the heart. The vagolytic (atropinic) activity of these compounds in cats relative to their neuromuscular blocking activity appeared to correlate well with their known liability to cause undesirable hypertension and tachycardia in man. The absence of cardiovascular effects after the administration of neuromuscular blocking doses of dimethyl tubocurarine would support its more extensive clinical use, but the need remains for a short-acting muscle relaxant with properties similar to those of dimethyl tubocurarine.

Topics: Acetylcholine; Alcuronium; Animals; Autonomic Nervous System; Blood Pressure; Cardiovascular System; Cats; Dose-Response Relationship, Drug; Gallamine Triethiodide; Ganglia, Autonomic; Heart Rate; Hypertension; Muscles; Neuromuscular Blocking Agents; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Nictitating Membrane; Pancuronium; Tachycardia; Tubocurarine

Hypertension immediately after coronary surgery is a problem in about one third of the patients so treated. This report discusses the possible causes of postoperative hypertension and describes several means of controlling the complication.

Topics: Acute Disease; Anesthesia, Inhalation; Coronary Vessels; Humans; Hypertension; Methoxyflurane; Nitroglycerin; Nitroprusside; Nitrous Oxide; Oxygen; Pancuronium; Postoperative Complications; Promazine; Tubocurarine

Topics: Adult; Aged; Anesthesia, Intravenous; Anesthesia, Local; Arteriosclerosis; Blood Pressure; Carotid Arteries; Carotid Sinus; Electrodes; Endarterectomy; Female; Humans; Hypertension; Male; Manometry; Middle Aged; Nitrous Oxide; Oscillometry; Oxygen; Pancuronium; Sodium; Thiopental; Trichloroethylene

Topics: Blood Pressure; Coronary Artery Bypass; Drug Interactions; Female; Halothane; Heart Rate; Hemodynamics; Humans; Hypertension; Middle Aged; Morphine; Pancuronium

Topics: Anesthesia, General; Aortic Coarctation; Blood Pressure Determination; Child; Child, Preschool; Halothane; Humans; Hypertension; Hypotension, Controlled; Infant; Nitrous Oxide; Pancuronium; Pentolinium Tartrate; Postoperative Complications; Tubocurarine

Topics: Anesthesia, Dental; Anesthesia, General; Dihydroxyphenylalanine; Female; Halothane; Humans; Hypertension; Hypotension; Middle Aged; Pancuronium; Parkinson Disease; Postoperative Complications